Prediction of stentless aortic bioprosthesis size with transesophageal echocardiography and magnetic resonance imaging.

BACKGROUND AND AIMS OF THE STUDY

During stentless bioprosthetic aortic valve replacement, ischemic time may be decreased by the non-invasive prediction of bioprosthesis size, allowing earlier commencement of prosthesis preparation. In this study we examine whether the addition of transesophageal echocardiography (TEE) to transthoracic echocardiography (TTE) aids in the prediction of stentless bioprosthesis aortic valve size. We also report our preliminary experience with the use of magnetic resonance imaging (MRI) in bioprosthetic valve size prediction.

METHODS

Eight patients in whom elective aortic valve replacement with a Toronto SPV valve was planned underwent preoperative TTE and MRI, and intraoperative TEE.

RESULTS

In all cases the combination of TTE and TEE correctly predicted the size of Toronto SPV valve inserted. In three cases, TEE led to a revision of the TTE-based prediction. The need for sinotubuloplasty in two patients was correctly predicted by both TTE and TEE. MRI of the aortic annulus correctly predicted valve size in three of four cases, but could not reliably identify the sinotubular junction.

CONCLUSIONS

In aortic valve replacement the accuracy of prediction of stentless bioprosthesis size is improved by the addition of TEE to TTE.